Amiodarone
Class III
| IV Dose | 5 mg/kg over 15-30 mins.. Repeat if necessary in 15 minutes. Drip 10-20 mg/kg/day. Must be given by central line in D5W. |
| Oral dose | Loading: 5 mg/kg given BID x 10 days (max 1.2grams/day) Then 5 mg/kg QD for 1-2 months. Attempt to decrease progressively to 2.5 mg/kg in small changes every 4-6 months. |
| Levels | Useful to document gross noncompliance. Therapeutic > 1.0 ug/ml. Toxicity common at > 2.5 ug/ml. |
| Kinetics | Complex and obscure. Extensive rapid uptake by adipose tissue, slow uptake by myocardium, concentrates in both. Elimination half-life about 30 days with chronic oral therapy. (Range 8-107 days) Levels detectable 9 months after stopping Rx. Therapeutic effect seen 1-3 hours after IV dose. Peak serum level at 5 hours after oral dose |
| Cautions | Many. In particular, extreme sinus bradycardia requiring a pacemaker is frequent. 25% incidence of marked hypotension and decreased contractility with IV administration only. |
| Interactions | Potentiates warfarin action. Digoxin levels progressively rise 70-100%. With beta blockers and calcium channel blockers, causes severe sinus bradycardia.Potentiates tendency of quinidine, propafenone and mexiletine to cause Torsades de pointes. Increases levels of quinidine, procainamide, phenytoin, flecainide, and cyclosporin |
| Preparations | Cordarone scored tablets, 200 mg. Cordarone injection, 50 mg/cc, 3 cc ampuls |
| FDA approval in children | no |